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ObjectivesTo describe the global trends of pulmonary nontuberculous mycobacteria (NTM) infection and disease.MethodsA systematic review of studies including culture-based NTM data over time. Studies reporting on pulmonary NTM infection and/or disease were included. Information on the use of guideline-based criteria for disease were collected, in which, infection is defined as the absence of symptoms and radiological findings compatible with NTM pulmonary disease. The trends of change for incidence/prevalence were evaluated using linear regressions, and the corresponding pooled estimates were calculated.ResultsMost studies reported increasing pulmonary NTM infection (82.1%) and disease (66.7%) trends. The overall annual rate of change for NTM infection and disease per 100,000 persons/year was 4.0% (95% confidence interval [CI]: 3.2-4.8) and 4.1% (95% CI: 3.2-5.0), respectively. For absolute numbers of NTM infection and disease, the overall annual change was 2.0 (95% CI: 1.6-2.3) and 0.5 (95% CI: 0.3-0.7), respectively. An increasing trend was also seen for Mycobacterium avium complex infection (n = 15/19, 78.9%) and disease (n = 10/12, 83.9%) and for Mycobacterium abscessus complex (n = 15/23, 65.2%) infection (n = 11/17, 64.7%) but less so for disease (n = 2/8, 25.0%).ConclusionOur data indicate an overall increase in NTM worldwide for both infection and disease. The explanation to this phenomenon warrants further investigation. Objectives: To describe the global trends of pulmonary nontuberculous mycobacteria (NTM) infection and disease.Methods: A systematic review of studies including culture-based NTM data over time. Studies reporting on pulmonary NTM infection and/or disease were included. Information on the use of guideline-based criteria for disease were collected, in which, infection is defined as the absence of symptoms and radiological findings compatible with NTM pulmonary disease. The trends of change for incidence/prevalence were evaluated using linear regressions, and the corresponding pooled estimates were calculated.Results: Most studies reported increasing pulmonary NTM infection (82.1%) and disease (66.7%) trends. The overall annual rate of change for NTM infection and disease per 10 0,000 persons/year was 4.0% (95% confidence interval [CI]: 3.2-4.8) and 4.1% (95% CI: 3.2-5.0), respectively. For absolute numbers of NTM infection and disease, the overall annual change was 2.0 (95% CI: 1.6-2.3) and 0.5 (95% CI: 0.3-0.7), respectively. An increasing trend was also seen for Mycobacterium avium complex infection (n = 15/19, 78.9%) and disease (n = 10/12, 83.9%) and for Mycobacterium abscessus complex (n = 15/23, 65.2%) infection (n = 11/17, 64.7%) but less so for disease (n = 2/8, 25.0%).Conclusion: Our data indicate an overall increase in NTM worldwide for both infection and disease. The explanation to this phenomenon warrants further investigation.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Control of swine influenza A virus (swIAV) in North America and Europe is complicated because multiple antigenically distinct swIAV strains co-circulate in the field, and no vaccine is available that can provide broad cross-protection against all these swIAVs. In 2017, the first live attenuated influenza vaccine (LAIV) for swine was licensed in the US. The non-structural protein 1 (NS1)-truncated cluster I H3N2 strain A/swine/Texas/4199-2/98 NS1del126 (TX98 LAIV) in this vaccine provides partial cross-protection against heterologous North American cluster II and IV H3N2 swIAV strains. Its efficacy against European or more recent North American H3N2 lineages remains to be investigated. In this study, we evaluated the level of cross-protection against heterologous IAVs representative of the major H3N2 swIAV lineages in Europe and North America. TX98 LAIV prevented both nasal shedding and replication in the lungs of a North American cluster IV H3N2 swIAV for 2/4 pigs, prevented considerable nasal shedding of a North American novel human-like H3N2 swIAV for 2/4 pigs, and reduced replication of a European H3N2 swIAV in the lower respiratory tract to minimal titers for 1/3 pigs. Although TX98 LAIV elicited neutralizing antibodies against the homologous virus in serum and to a lesser extent in nose and lungs, no significant cross-reactive antibody titers against the heterologous swIAVs were detected. Partial cross-protection therefore likely relies on cellular and mucosal immune responses against conserved parts of the swIAV proteins. Since TX98 LAIV can offer partial protection against a broad range of H3N2 swIAVs, it might be a suitable priming vaccine for use in a heterologous prime-boost vaccination strategy.

Background: Cannabis use and cannabis use disorder (CUD) are associated with mental health disorders, however the extent of this matter among pregnant and recently postpartum (e.g., new moms) women in the US is un-known. Associations between cannabis use, DSM-5 CUD and DSM-5 mental health disorders (mood, anxiety, personality and post-traumatic stress disorders) were examined among a nationally representative sample of pregnant and postpartum women.Methods: The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III was used to examine associations between past-year cannabis use, CUD and mental health disorders. Weighted logistic regression models were used to estimate unadjusted and adjusted odds ratios (aORs). The sample (N=1316) included 414 pregnant and 902 postpartum women (pregnant in the past year), aged 18-44 years old.Results: The prevalence of past-year cannabis use and CUD was 9.8% and 3.2%, respectively. The odds of cannabis use (aORs range 2.10-3.87, p-values

Research on how socioeconomic status interacts with neighbourhood characteristics to influence disparities in obesity outcomes is currently limited by residential segregation-induced structural confounding, a lack of empirical studies outside the U.S. and other 'Western' contexts, and an over-reliance on cross-sectional analyses. This study addresses these challenges by examining how socioeconomic status modifies the effect of accumulated exposures to obesogenic neighbourhood environments on children and mothers' BMI, drawing from a longitudinal mother-child birth cohort study in Singapore, an Asian city-state with relatively little residential segregation. We find that increased access to park connectors was associated with a decrease in BMI outcomes for mothers with higher socioeconomic status, but an increase for those with lower socioeconomic status. We also find that increased access to bus stops was associated with an increase in BMIz of children with lower socioeconomic status, but with a decrease in BMIz of children with higher socioeconomic status, while increased access to rail stations was associated with a decrease in BMIz of children with lower socioeconomic status only. Our results suggest that urban interventions might have heterogeneous effects by socioeconomic status.

BACKGROUND: Health economic evaluations are often required before implementing a vaccination programme. Such evaluations rarely consider the historical context of a vaccination programme. We review the financial history of vaccination programmes in the Netherlands, and compare these to demographic and macroeconomic developments as well as avoided mortality burden.METHODS: Previously uncatalogued historical expenditures on the Dutch National Immunisation Programme (NIP) and influenza vaccination were obtained from official reports. Costs were adjusted for inflation using Consumer Price Indices and expressed in Euro of 2016. Estimates on mortality burden averted were obtained from previous research and used to calculate the ratio of expenses to averted mortality burden for vaccinations against diphtheria, tetanus, pertussis, polio, measles, mumps and rubella for birth cohorts 1953-1992.RESULTS: Developments towards a uniform government funded NIP started early 1950s with vaccinations against diphtheria, pertussis and tetanus, culminating in its official launch in 1957 together with polio vaccinations. Since the 1980s, expenditure increased nearly five-fold mostly due to the addition of new vaccines, while spending on already implemented vaccinations tended to decline. Overall, expenditure increased from € 5 million in 1957 to € 93 million in 2014. Relative to total healthcare expenditure, the NIP contributed little, ranging between 0.05% and 0.14%. Spending on influenza vaccination increased from € 37 million in 1996 to € 52 million in 2014, while relative to total healthcare expenditure it decreased from 0.069% to 0.055%. In 2014, 0.15% of healthcare expenditure and € 533 per birth was spent on vaccination programmes. Overall, for birth cohorts 1953-1992, € 5.4 thousand (95% confidence interval: 4.0-7.3) was expended per year-of-life-lost averted.CONCLUSION: The actual costs per year-of-life gained are more favorable than estimated here since averted medical costs were not included. Although expenditure on vaccination programmes increased substantially, the contribution to overall healthcare expenditure remained small.

Objectives: Pain is a highly prevalent problem in older adults and dying patients. Opioids are the main analgesic for moderate to severe pain in these patients. Different properties of various opioids can make them more or less suitable for this specific population. We therefore aim to explore opioid prescribing behavior in a group of physicians specialized in long-term geriatric care and to identify factors that are taken into account when selecting a specific opioid for treatment of pain in older patients and patients in the dying phase.Design: A cross-sectional study using an online questionnaire.Setting and Participants: All members of the Dutch Association of Elderly Care Physicians and Social Geriatricians (Verenso) on the mailing list of the weekly digital newsletter were invited to participate between November and December 2017.Measures: Preferences in opioids for the treatment of pain in nondying and dying older patients were recorded, as were the factors that were considered for these preferences.Results: 142 members completed the questionnaire (9%). Opioids of first choice were oxycodone (61%) for nondying and morphine (90%) for dying older patients. The second choice in both cases was fentanyl (56% for nondying and 31% in dying older patients). Personal experience was the main consideration in opioid prescribing (74%-98%). In daily practice, recommendations in guidelines are only considered by 8% to 9% and renal function by 0% to 1% of the respondents.Conclusions/Implications: Oxycodone is the opioid of first choice for physicians in long-term geriatric care in the Netherlands when prescribing for nondying older patients. In contrast, morphine is preferred for dying patients. Fentanyl as a second choice is mainly reserved for situations of stable pain. Prescribers base their choices almost exclusively on personal experience and are barely influenced by guidelines. Further research should therefore focus on clinical relevance for, and implementation in, daily practice. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Available online: 09 August 2018 This paper examines the cross-quantile dependence between developed and emerging market stock returns and investigates its time-varying characteristics, using recursive sample estimations. The results based on cross-quantilogram approach reveal a heterogeneous quantile relation for the USA, UK, German, and Japanese stock returns to those of the emerging markets. Systematic risk generally does not explain the cross-country dependence structure, since it remains essentially unchanged when controlling for financial, geopolitical, and economic uncertainties. Moreover, the cross-quantile correlation changes over time, especially in the low and high quantiles, indicating that it is prone to jumps and discontinuities, even in a seemingly stable dependence structure. These results are important for institutional investors and market observers. UAEU UPAR Grant [G00001895] Jan Wallander and Tom Hedelius Foundation

Over the past 50 years, family formation trajectories have undergone major changes in the events that occur as well as in the timing and order of these events. Whereas previous studies showed when and how these shifts occur, not much research has been conducted to test why these changes have taken place. This paper tests two possible explanations, namely cultural (secularization) and economic (youth unemployment) change using the Fertility and Family survey of the Netherlands conducted in 2008. We also employed a new method, Competing Trajectories Analysis (CTA), which combines features of sequence analysis and event history analysis, to examine the relationship between secularization and youth unemployment and pathways into adulthood. Our results show that the start of family formation is postponed in times of high secularization and youth unemployment, when pathways including early marriage and parenthood become less popular, and cohabiting without having children becomes more popular.

Hypertension is an important public health challenge because of its high prevalence and strong association with cardiovascular disease and premature death. Hypertension is a major cause of CKD, is present in more than 80% of CKD patients, and contributes to CKD progression. Risk factors for hypertension include, but are not limited to, age, race, family history, obesity, physical inactivity, tobacco use, and inadequate intake of minerals such as calcium, potassium, and magnesium. Magnesium is the second most abundant intracellular cation in the human body and plays an important role in insulin and adenosine triphosphate metabolism. Low dietary magnesium intake has been associated with an increased risk of developing hypertension in prospective cohort studies. Moreover, clinical trials suggest that magnesium supplementation has blood pressure lowering effects. In addition, emerging data reveal potential mechanisms by which magnesium may influence blood pressure. Here, we will review these mechanisms, using a physiology-based approach, focusing on the effects of magnesium on total peripheral resistance and cardiac output. (C) 2018 by the National Kidney Foundation, Inc. All rights reserved.

National climate policies are shaped by international organizations (IOs) and global norms. Drawing from World Society Theory and the Advocacy Coalition Framework (ACF), we develop two related arguments: (1) one way in which IOs can influence national climate policy is through their engagement in mass-mediated national policy debates and (2) national organizations involved in the policy process may form advocacy coalitions to support or oppose the norms promoted by IOs. To examine the role of IOs in national policy debates and the coalitions that support and oppose them, we use discourse network analysis (DNA) on over 3500 statements in 11 newspapers in Canada, the United States (US), Brazil, and India. We find that in the high-income countries that are high per capita emitters (Canada and the US), IOs are less central in the policy debates and the discourse network is strongly clustered into competing advocacy coalitions. In the lower-income countries that are low per capita emitters (Brazil and India), IOs are more central and the discourse network is less clustered. Relating these findings to earlier research, we suggest that the differences we find between high and low per capita emitters may be to some extent generalizable to the relevant country groups beyond our four cases.

Este artículo contiene 1 página, 1 tabla, 1 figura y 1 apéndice con una tabla., Marine Recreational Fishing (MRF) is an important activity in Europe, with 9 million fishers and generating annually € 6 billion in direct expenditures. However, there is a lack of data and understanding of MRF in Europe, particularly in Southern countries, which prevents a number of fish stocks from being effectively assessed and managed. In November 2016, a participatory workshop on MRF was held in Vigo (Spain) to identify challenges and opportunities for data collection, and to diagnose key research gaps and management issues for MRF in the Southern European Atlantic. Experts from a wide range of disciplines (researchers, policy makers, fisheries managers and commercial and recreational fishers) highlighted that the management of MRF is a challenge due to complex and dispersed legal frameworks, with multiple administrations involved, and overlapping uses of space with commercial fishing, aquaculture, navigation and tourism, among others. The lack of strong and representative fishing associations hampers research and management initiatives. Effective communication between recreational fishers, researchers and fisheries managers is also lacking. Despite the ecological, social and economic relevance of MRF, there is no systematic and comprehensive collection of information on fishing effort, recreational catches, expenses, social profile and access conditions of European recreational fishers. These data would be useful to avoid biases in the assessment of recreational fisheries due to the great diversity of ecosystems, species and typologies of users. Strategic recommendations and research priorities were also identified to address knowledge gaps and are discussed in the context of the management of MRF across Europe., The 1st Workshop on Recreational Fishing on the Iberian Atlantic Coast was co-convened by the Federación Gallega de Pesca Marítima Responsible y Náutica de Recreo, WWF-Spain, the Federación Gallega de Actividades Subacuáticas, the International Forum for Sustainable Underwater Activities and the Universities of Santiago de Compostela, Minho and Aveiro. The workshop was also supported by the Confederación Española de Pesca Recreativa Responsible, the Federación Galega de Confrarías de Pescadores and the Autonomous Government of Galicia. The workshop was funded by the Autonomous Government of Galicia, RECREGES project under Grant [ED481B2014/034-0], by the conveners and through financial contributions of Baitra Accesorios Navales, Disvent Ingenieros, Jesús Betanzos Efectos Navales, Talleres Franinox and Yamaha. CP would also like to acknowledge FCT/MEC national funds and FEDER co-funding, within the PT2020 partnership Agreement and Compete 2020, for the financial support to CESAM, under Grant [UID/AMB/50017/2013].

Income is a strong predictor of adult mortality. Measuring income is not as simple as it may sound. It can be conceptualized at the individual or the household level, with the former better reflecting an individual's earning ability, and the latter better capturing living standards. Furthermore, respondents are often grouped into income categories based on their positions in the income distribution, and this operationalization can be done on the basis of age-specific or total population income distributions. In this study, we look at how four combinations of different conceptualizations (individual vs. household) and operationalizations (age-specific vs. total population) of income can affect mortality inequality estimates. Using Finnish registry data, we constructed period life tables for ages 25+ from 1996 to 2017 by gender and for four income definitions. The results indicated that the slope index of inequality for life expectancy varied by 1.1–5.7 years between income definitions, with larger differences observed for women than for men. The overall age patterns of relative index of inequality for mortality rates yielded by the four definitions were similar, but the levels differed. The period trends across income definitions were consistent for men, but not for women. We conclude that researchers should pay particular attention to the choice of the income definitions when analyzing the association between income and mortality, and when comparing the magnitude of inequality across studies and over time., Highlights • We examined how income definitions impact estimates of mortality inequality by income. • Different income definitions substantially affected the level of mortality inequality. • Period patterns across income definitions were consistent for men but not for women. • Age patterns of mortality inequality were consistent across income definitions. • The overall impact of income definitions is larger for women than for men.

Differences in global market integration across industries have important repercussions for MNC strategy and the drivers of manufacturing subsidiary divestment decisions. Global industry integration and the associated competitive pressures lead MNCs to adopt cost efficiency strategies for their subsidiary networks, and subsidiary divestment decisions are strongly driven by labor cost considerations. In non-integrated industries, host country demand conditions are the prime driver of divestments. These patterns are the most salient for MNCs that have aligned their strategy with the global industry environment. Analysis of the divestment hazards of 3827 Japanese manufacturing subsidiaries in 57 countries provides support for these conjectures.

Summary The shift of attention from the decline of organized religion to the rise of post-Christian spiritualities, anti-religious positions, secularity, and religious indifference has coincided with the deconstruction of the binary distinction between “religion” and “non-religion”—initiated by spirituality studies throughout the 1980s and recently resumed by the emerging field of non-religion studies. The current state of cross-national surveys makes it difficult to address the new theoretical concerns due to (1) lack of theoretically relevant variables, (2) lack of longitudinal data to track historical changes in non-religious positions, and (3) difficulties in accessing small and/or hardly reachable sub-populations of religious nones. We explore how user profiling, text analytics, automatic image classification, and various research designs based on the integration of survey methods and big data can address these issues as well as shape non-religion studies, promote its institutionalization, stimulate interdisciplinary cooperation, and improve the understanding of non-religion by redefining current methodological practices., The bigger picture It is becoming increasingly clear that secularity and non-religion are progressively turning into a relevant component of social life in both western and non-western countries and that they are connected with a variety of pressing issues such as civic engagement, human rights, and social integration. While traditional methodological approaches remain important to understand the varieties of non-religion, Big Data can significantly shape the way in which social scientists frame and analyze the puzzles within this emerging academic field. Nevertheless, large unstructured data collections and classification algorithms remain widely underused in sociology of religion, hindering its potential. We argue that to let Big Data in means to build an interconnected, interdisciplinary, and cooperative field situated at the intersection of non-religion studies and data science., For decades, the scientific community collected data about religion and beliefs using questionnaires that were not developed with the issue of non-religion in mind. This is why the new field of non-religion studies faces major difficulties in opening up this category for critical empirical scrutiny. User profiling, text analytics, automatic image classification, and various research designs based on integration of survey methods and Big Data can help researchers to address these issues.

State-of-the-art research suggests that energy systems are best evaluated using exergy analysis, as exergy represents the real value of an energy source, demonstrating it to be the only rational basis for evaluation. After discovering the lack of thermodynamic integration into stock modelling, this paper presents the development of an exergy-based building stock model. The aim of this paper is twofold. Firstly, to investigate the impact of large-scale future energy retrofit scenarios in the English and Welsh (E&W) non-domestic sector, and secondly, to determine the potential of exergy analysis in improving sectoral efficiency and its potential implications on exergy-oriented policy making. The research explores seven different large-scale future retrofit scenarios that encompass typical, low-carbon, and low-exergy approaches. Modelling results show that by 2050, current regulations have the potential to reduce carbon emissions by up to 49.0±2.9% and increasing sector thermodynamic efficiency from 10.7% to 13.7%. On the other hand, a low-exergy oriented scenario based on renewable electricity and heat pumps is able to reduce carbon emissions by 88.2±2.4%, achieving a sectoral exergy efficiency of 19.8%. This modelling framework can provide energy policy makers with new insights on policy options based on exergy indicators and the assessment of their potential impact.

Because of the great variability of their reservoir hosts, hantaviruses are excellent models to evaluate the dynamics of virus-host co-evolution. Intriguing questions remain about the timescale of the diversification events that influenced this evolution. In this paper we attempted to estimate the first ever timing of hantavirus diversification based on thirty five available complete genomes representing five major groups of hantaviruses and the assumption of co-speciation of hantaviruses with their respective mammal hosts. Phylogenetic analyses were used to estimate the main diversification points during hantavirus evolution in mammals while host diversification was mostly estimated from independent calibrators taken from fossil records. Our results support an earlier developed hypothesis of co-speciation of known hantaviruses with their respective mammal hosts and hence a common ancestor for all hantaviruses carried by placental mammals. (C) 2017 Elsevier B.V. All rights reserved.

Objective: To estimate and compare the lifetime risk of total knee replacement surgery (TKR) for osteoarthritis (OA) between countries, and over time.Method: Data on primary TKR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of TKR was calculated for 2003 and 2013 using registry, life table and population data.Results: Marked international variation in lifetime risk of TKR was evident, with females consistently demonstrating the greatest risk. In 2013, Finland had the highest lifetime risk for females (22.8%, 95% CI 22.5-23.1%) and Australia had the highest risk for males (15.4%, 95% CI 15.1-15.6%). Norway had the lowest lifetime risk for females (9.7%, 95% CI 9.5-9.9%) and males (5.8%, 95% CI 5.6-5.9%) in 2013. All countries showed a significant rise in lifetime risk of TKR for both sexes over the 10-year study period, with the largest increases observed in Australia (females: from 13.6% to 21.1%; males: from 9.8% to 15.4%).Conclusions: Using population-based data, this study identified significant increases in the lifetime risk of TKR in all five countries from 2003 to 2013. Lifetime risk of TKR was as high as 1 in 5 women in Finland, and 1 in 7 males in Australia. These risk estimates quantify the healthcare resource burden of knee OA at the population level, providing an important resource for public health policy development and healthcare planning. (C) 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Each year, more than 2 million women are diagnosed with breast or cervical cancer, yet where a woman lives largely determines whether she will develop one of these cancers, have access to timely and effective diagnostic and treatment services, and ultimately survive. Premature death and disability from cancer is a preventable tragedy for hundreds of thousands of women and their families every year. In regions with limited resources, and a fragile or fragmented health system, cancer contributes to the cycle of poverty. This is most striking for cervical cancer, as more than eight in ten women diagnosed and nine in ten women who die from cervical cancer live in a low- or middle-income country. There are proven and cost-effective approaches to reduce these disparities, yet for most women there are few opportunities to access life-saving interventions such as HPV vaccination, and cervical cancer screening with timely treatment of pre-cancerous lesions. These longstanding inequities highlight the urgent need for substantive and sustainable investments in cancer control more broadly, including prevention and early detection programs, capacity building for health service infrastructure and human resources for cancer management including all disciplines: pathology, surgery, radiotherapy, systemic therapy as well as palliative care. Equally vital is the development of high-quality population-based cancer registries, particularly in low- and middle-income countries. In this first Series paper we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality and survival; the social and economic impact on women and their families; and the disparities in cancer survival among socioeconomically disadvantaged women in different settings.

Norovirus is a frequent cause of acute gastroenteritis and is usually spread through the fecal-oral route. Most patients will recover with supportive care, but in immunocompromised patients, norovirus can be debilitating. Since norovirus has a low infective dose, a sturdy viral structure, and can spread easily within a ward or unit, infection control guidelines should be followed closely when a patient is admitted with norovirus.

Alcohol consumption is the third leading risk factor for disease and mortality in Europe. As evaluated by the International Agency for Research on Cancer (IARC) Monographs, a causal relationship is established for consumption of alcoholic beverages and cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and female breast, even at low and moderate alcohol intakes. The higher the amount of alcohol consumed, the higher the risk of developing cancer. In Europe, an estimated 10% (95% CI: 7%–13%) of all cancer cases in men and 3% (95% CI: 1%–5%) of all cancer cases in women are attributable to alcohol consumption. Several biological mechanisms explain the carcinogenicity of alcohol; among them, ethanol and its genotoxic metabolite, acetaldehyde, play a major role. Taking all this evidence into account, a recommendation of the 4th edition of European Code against Cancer is: “If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.”

Globally, India's population is amongst the most severely impacted by nutrient deficiency, yet millions of tonnes of food are lost along the supply chain before reaching consumers. Across food groups, grains represent the largest share of daily calories and overall losses by mass in India. This study quantifies energy input to minimise storage losses across India, responsible for up to a quarter of grain losses. In doing so, we explore links between three Sustainable Development Goals-SDG2, SDG7, and SDG12-, and provide insight for development of joined up agriculture and health policy in the country. Focusing on rice, wheat, maize, bajra, and sorghum, we quantify one route to reduce losses in supply chains, by modelling the energy input to maintain favourable climatic conditions in modern silo storage. We quantify key nutrients (calories, protein, zinc, iron, vitamin A) contained within these losses, and calculate roughly how much deficiency in these dietary components could be reduced if grain losses were eliminated. Our modelling indicates that maize has the highest energy input intensity for storage, at 110 (18) kWh per tonne of grain (kWh/t), and wheat the lowest, at 72 (14) kWh/t. This energy cost represents 8%-16% of the energy input required in grain production. We estimate if grain losses across the supply chain were saved and targeted to India's nutritionally deficient population, average protein deficiency could reduce by 46±4%, calorie by 27±2%, zinc by 26±2% and iron by 11±1%.

Working memory (WM) plays a critical role in cognitive control by shielding self-regulatory goals from distraction by desire-related thoughts and emotions. This study examined whether training WM increases self-regulation in overweight participants. It was hypothesized that WM training would decrease psychopathological eating-related thoughts, (over)consumption of food in response to emotions and external cues, food intake and body weight. Overweight participants (n = 50) performed 20-25 sessions of WM training or control/sham training. The dependent measures were self-reported eating-related psychopathology, self-reported emotional/external eating behavior, food intake during a bogus taste test, and body weight, assessed before training, immediately following training, and at one-month follow-up. Relative to control, WM training reduced psychopathological eating-related thoughts and emotional eating (but not external eating). These effects were still present at follow-up, one month later. Food intake and body weight did not show an overall effect of training, though WM training did reduce food intake among highly restrained participants. WM training effectively reduced eating-related thoughts, overeating in response to negative emotions, and food intake among participants with strong dietary restraint goals. Hence, these findings indicate that WM training may strengthen self-regulation by shielding dieting goals from distraction by unwanted eating-related thoughts and emotions.

Item does not contain fulltext INTRODUCTION: Pertussis cocooning is one of the strategies aiming to prevent the potential harm of pertussis in infants by vaccinating (among others) their parents. Several countries adopted this strategy, but uptake is a problem. Determinants of parental uptake are important in the design of an effective vaccination programme. Therefore, this study aims to assess parents' intention to accept a pertussis cocooning vaccination and its determinants. METHODS: A 98 item questionnaire was developed based on a theoretical framework, assessing parents' intention to accept a pertussis cocooning vaccination and its personal and psychosocial determinants. In addition, beliefs underlying parents' attitude towards pertussis cocooning vaccination were assessed. Both logistic and linear regression analysis were used to assess univariate and multivariate associations amongst study variables. RESULTS: Parents returned 282 questionnaires. The majority of the parents (78%) reported a positive intention to accept a pertussis cocooning vaccination. Attitude (OR 6.6, p

Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors.

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...

The bovine milk fat globule membrane (MFGM) is a source of food-derived glycans that can offer an approach to prevent Escherichia coli O157:H7 infection by inhibiting attachment of the pathogen to host cells. Such glycans may decrease the need for antibiotic treatment by acting as prophylactics. In this study, we generated a defatted bovine MFGM fraction, rich in proteins and glycoproteins, and demonstrated its ability to prevent the association of several enterohaemorrhagic E. coli O157:H7 strains with human colonic adenocarcinoma, HT-29 cells. This defatted MFGM fraction reduced bacterial association with HT-29 cells in a concentration dependent and strain specific manner. This study may present a new approach to mitigate the adverse health effects caused by E. coli infections in humans.

Travellers' diarrhoea (TD) remains the most frequent health problem encountered by visitors to the (sub) tropics. Traditional stool culture identifies the pathogen in only 15% of cases. Exploiting PCR-based methods, we investigated TD pathogens with a focus on asymptomatic travellers and severity of symptoms. Pre- and post-travel stools of 382 travellers with no history of antibiotic use during travel were analysed with a multiplex quantitative PCR for Salmonella, Yersinia, Campylobacter, Shigella, Vibrio cholerae and five diarrhoeagenic Escherichia coli: enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC) and enteroinvasive (EIEC). The participants were categorized by presence/absence of TD during travel and on return, and by severity of symptoms. A pathogen was indentified in 61% of the asymptomatic travellers, 83% of those with resolved TD, and 83% of those with ongoing TD; 25%, 43% and 53% had multiple pathogens, respectively. EPEC, EAEC, ETEC and Campylobacter associated especially with ongoing TD symptoms. EAEC and EPEC proved more common than ETEC. To conclude, modern methodology challenges our perception of stool pathogens: all pathogens were common both in asymptomatic and symptomatic travellers. TD has a multibacterial nature, but diarrhoeal symptoms mostly associate with EAEC, EPEC, ETEC and Campylobacter. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

While previous research has identified cultural values and emotional intelligence as central determinants of conflict handling styles, little is known about the mechanism through which cultural values impact individuals' preferences for specific conflict handling styles. Based on a multinational dataset including 1527 individuals from ten different cultural clusters, the current study aims to integrate these two literature streams by examining the influence of cultural values on conflict handling styles through emotional intelligence. The results of structural equation modeling and mediation analysis show that in particular uncertainty avoidance and long-term orientation influence preferences for the conflict handling styles of compromising, obliging, and integrating through emotional intelligence. Furthermore, we find that collectivism has a direct negative effect on the preference for a dominating style and that power distance has a direct positive effect on the preference for an avoiding and a dominating style. Our study contributes to a more comprehensive and more integrative understanding of earlier research on the role of culture and emotional intelligence in conflict handling. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.

Introduction: Aortic prosthetic graft infection (AGI) is a major challenge in vascular surgery. Eradicating the. infection requires prosthetic material removal, debridement, and lower limb revascularization. For the past 15 years, we have used femoral veins for aorto-iliac reconstruction and tensor fascia lata to strengthen the upper anastomosis. Objective: The purpose of this single institution retrospective study is to present results regarding in situ replacement of infected aortic grafts with autologous femoral veins (FVs). Methods: From October 2000 to March 2013, patients treated for AGI with graft removal and autologous FV reconstruction at Helsinki University Hospital were included. Primary outcome measures were 30 day mortality, long-term treatment related mortality, and re-infection rate. Secondary outcome measures were long-term all cause mortality and event free survival (graft rupture, re-intervention, major amputation). Results: During a 13 year period 55 patients (42 male, 13 female) were operated on using a venous neo-aorto-iliac system for AGI. The mean follow up was 32 months (1-157 months). The 30 day mortality rate was 9% (5) and overall treatment related mortality 18% (10). All cause mortality during follow up was 22 (40%) and overall Kaplan-Meier survival was 90.7% at 30 days, 81.5% at 1 year, and 59.3% at 5 years. Graft rupture occurred in three (5%) cases, two of which were caused by graft re-infection. (4%). Four patients required major amputation, one of them on arrival and three (5%) during the post-operative period. Nine (16%) patients needed interventions for the vein graft, and two graft limbs occluded during follow up. Conclusion: In situ reconstruction for aortic graft infection with autologous FV presents acceptable rates of morbidity and mortality, and remains the treatment of choice for AGI at Helsinki University Hospital. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Background and aims: In our previous study, the annual number of adolescents treated at Helsinki Children's Hospital and Toolo Trauma Centre for injuries from moped and scooter accidents increased five-fold between 2002 and 2007. In June 2011, the requirements for a moped/scooter license changed to include driver's education and a vehicle handling evaluation. The aim of this retrospective study was to assess the influence of legislative changes on moped and scooter related serious injuries in adolescents. Patients and methods: Data from 520 patients (age 15-16) treated for trauma from moped and scooter accidents at our institutions between January 2008 and December 2013 were included. Case numbers were compared with population data from national databases. Overall incidence, trauma mechanism, injury profile, and proportion of patients requiring hospital admission were calculated for time periods before and after the law amendment. Results: After the law change in 2011, the annual incidence of moped/scooter injuries among 15-year-olds in our area decreased from 0.8% in 2011 to 0.3% in 2013 (p

Open access funding provided by Max Planck Society. The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged. Publisher PDF

Employee voice may have positive outcomes for organizations, however, encouraging employees to speak out is not guaranteed unless the organization signals that it is safe and effective for employees to do so. In this conceptual paper, we identify core variables that constitute the norms for voice created in organizations across national cultures. Developing a multilevel conceptual framework of employee voice, we explore how organizational norms related to different voice channels provide signals to employees about voice consequences, namely voice safety and effectiveness. Given organizations do not operate in contextual vacuums, we also apply a macro-level consideration of national culture values that influence organizational voice norms to affect safety and effectiveness signals. A conceptual framework and propositions for future research are presented.

•This paper investigates biases in the Bureau of Transport Statistics Origin-Destination Survey.•Roughly half of routes in the DB1B could not be accounted for.•Our algorithm can be used to identify potentially biased routes.•Further research could focus on the nature of biases in the presented databases.

Introduction: The global use of complementary and alternative medicine (CAM) is growing. The purpose of this study was to determine the prevalence of CAM use in patients in Turkey with CVH, the types of therapy, and patients' sociodemographic characteristics. Methods: The study was designed as a questionnaire-based, cross-sectional analysis. An infectious diseases outpatient follow-up questionnaire was administered to patients at face-to-face interviews. The data obtained were analyzed using SPSS 17 software. Results: This study included 588 patients, of whom 27% used CAM. No differences in sociodemographic characteristics were determined between patients using CAM and those not using it. Herbal methods were used by 63.6% of patients and cupping techniques by 25.4%. Education level was significantly correlated with herbal methods (p = 0.043). CAM use also increased in line with disease duration (p < 0.05). No difference in CAM use was determined between CHB patients using oral antiviral therapy and those not using it (p = 0.162). Conclusion: CAM use, particularly herbal products, is prevalent among Turkish adults with CVH. In case of use of herbal products in chronic viral hepatitis patients, toxicity and liver failure may develop as a result of herbal product-drug interactions. Physicians in the field of hepatology should, therefore, be aware of potential toxicity of CAM, especially in patients with chronic hepatitis liver diseases. WOS:000514023100014 2-s2.0-85074683275 PubMed: 31987221

An assessment of the Extreme Precipitation Events (EPEs) is important because of their potential impacts on the local livelihood, ecosystem, and water resource management. In the present study, the EPEs are defined by applying a non-parametric (95th percentile) approach over different climatic regions of Saudi Arabia using observed daily precipitation data for the period 1984–2016 obtained from 27 meteorological stations. The frequency, composite and correlation analyses are performed to evaluate the statistics of EPEs and their teleconnections. During the wet season (Nov-Apr), the frequency of the EPEs (≥25 mm/day) are higher over northeastern, central and southwestern coastal parts of Saudi Arabia. The composites and correlation analyses show that the EPEs over Saudi Arabia are associated with mid-latitude circumglobal wave train (CGT), which evolves a few days before the onset of EPEs and decays afterwards. The CGT modulates the upper-level trough over the Arabian Peninsula (AP) along with the surface anomalous low-pressure system that enhances moisture convergence, favoring the occurrence of EPEs over the region. The EPEs over Saudi Arabia are also associated with El Nino Southern Oscillation (ENSO), which shows that during the positive (negative) ENSO phase the frequency of EPEs increases (decreases) over the country. Moreover, the El Nino (with positive CGT) enhances the EPEs frequency over Saudi Arabia while vice-versa happens for La Nina (with negative CGT) phase.

Background Alcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. Methods All cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987–2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. Results A total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally. The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%–22.3%. Women were on average 2.5 years older than men. Conclusions On grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.

Background: In 2005, a randomized trial reported that chemoradiation including temozolomide improves survival of 18 to 70-year-old glioblastoma patients. Today, that chemoradiation therapy is the standard of care, and used frequently also for elderly patients. We assessed population-level changes in glioblastoma survival between 2000 and 2013 in Finland, with focus on elderly patients (>70 years) in order to assess if changes in treatment of glioblastoma are reflected also in population-based survival rates. Methods: We identified all patients (age ≥18 years) from the Finnish Cancer Registry (FCR) with a histopathological diagnosis of primary glioblastoma in 2000-2013. Patients were followed up until December 2015. The accuracy of register-based search of glioblastoma patients was internally validated. We report age-standardized relative survival ratios and relative excess risks of death (RER) between 2000-2006 (pre) and 2007-2013 (post-period). Findings: We identified 2,045 glioblastoma patients from the FCR. The accuracy of the FCR-based search was 97%. Median age was 63·3 years, and 42% were women. Incidence increased on average by 1·6% and median age by 0·4 years per calendar year. Between the pre and post-period, the proportion of patients >70 years increased from 24% to 27%. In >70-year-old patients, the median survival time increased from 3·6 months in 2000-2006 to 4·5 months in 2007-2013 (RER 0·82, 95% CI 0·68-0·98). In ≤70-year-old-patients, the median survival time increased from 9·3 months in 2000-2006 to 11·7 months in 2007-2013 (RER 0·74, 95% CI 0·67-0·82). Interpretation: Despite the increased proportion of elderly glioblastoma patients, population-level survival of glioblastoma patients have improved since year 2000. However, increasing incidence, increasing age of patients, and poor survival in elderly are alarming, and future studies should perhaps focus more on elderly. Funding: None Conflict of interest: The authors declare no conflict of interest Ethical Approval Statement: The data processing procedures were evaluated and approved by the Helsinki University Hospital’s research committee (HUS/356/2017 §107) and the National Institute for Health and Welfare THL (THL/1009/6.02.00/2018). We conducted the study according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines (Electronic Supplementary Material 1).

Introduction Following the major outbreak of pertussis and 14 infant deaths across England in 2012, the Department of Health (DH) introduced the UK's first maternal pertussis vaccination programme. Data published by Public Health England (PHE) suggest uptake of the vaccine varies considerably across the country. The reasons for this heterogeneity need to be addressed to optimise the impact of the programme. Objective To assess uptake of antenatal pertussis and influenza vaccine in a leading NHS Trust in London and to explore awareness and attitudes of pregnant women towards the pertussis vaccination programme. Design A cross sectional survey was conducted in an ethnically diverse group of 200 pregnant women accessing antenatal care at Imperial Healthcare NHS Trust. Quantitative data was tabulated and content analysis was carried out on the free text. Qualitative data was divided into themes for accepting or declining the vaccine. Results Awareness of the programme was 63% (126/200) with actual uptake of the vaccine only 26.0% (52/200). Women had received information from multiple sources, primarily General Practitioners (GP) and midwives. 34.0% (68/200) of women were offered the vaccine at their GP practice, only 24% reported a meaningful discussion with their GP about it. Uptake differed by up to 15.0% between ethnicities. Qualitative data showed that uptake could be significantly enhanced if vaccination was recommended by a familiar healthcare professional. Feeling uninformed, lack of professional encouragement and uncertainties of risk and benefit of the vaccine were the greatest barriers to uptake. Conclusion Vaccine uptake in this cohort of pregnant women was poor. Understanding the target audience and engaging with key groups who influence women's decision-making is essential. Knowledgeable health care professionals need to recommend the vaccine and provide accurate and timely information to increase success of this important programme.

Background: Prenatal health care is pivotal in providing adequate prevention and care to pregnant women.Aim: We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.Methods: We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.Findings: We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.Conclusion: Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

We estimate a New-Keynesian macro model accommodating regime-switching behavior in monetary policy and in macro shocks. Key to our estimation strategy is the use of survey-based expectations for inflation and output. We identify accommodating monetary policy before 1980, with activist monetary policy prevailing most but not 100% of the time thereafter. Systematic monetary policy switched to the activist regime in the 2000-2005 period through an aggressive lowering of interest rates. Discretionary policy spells became less frequent since 1985, but the Volcker period is identified as a discretionary period. Output shocks shift to the low volatility regime around 1985 whereas inflation shocks do so only around 1990, suggesting active monetary policy may have played role in anchoring inflation expectations. Shocks and policy regimes jointly drive the volatility of the macro variables. We provide new estimates of the onset and demise of the Great Moderation and the relative role played by macro-shocks and monetary policy.

This article outlines the findings from a Delphi study aimed to generate insights from a systems perspective about responding to climate change in terms of food safety of fresh produce. The study identified pressures to food safety of fresh produce at primary production, related to contamination of water sources and production environment with microorganisms, pesticide residues, mycotoxins and heavy metals due to heavy rainfalls and floods, droughts, increased temperature and change in seasonality, as results of climate change. First response to these pressures is realised by the core control activities implemented at farm, and depends on their current implementation and actual operation. The experts highlighted the need to strengthen activities, such as water control (including water treatment and quality monitoring), irrigation method, pesticide management (and pre-harvest intervals), personal hygiene requirements and (cold) storage control. Validating the effectiveness of control activities for the changed circumstances, guidance and training to the farmers was emphasized. Moreover, response strategies were proposed for farms to cope with the pressures immediately after occurring and to adapt long-term with support at the community level. The participating experts represented countries from the global north with industrialised food systems, and from the global south — with structured and traditional food systems. They assessed the likelihood of most pressures as higher for the countries from the global south, which was explained by existing response strategies in the global north. It was proposed that the adaptive and coping capacities of companies, regions and sectors are determined by the currently available adaptation and coping strategies. The pressures to food safety can differ per company, supply chain, region and sector due to variability of current climate vulnerabilities, control activities, and adaptive capacity. This paper argues that future adaptation actions should take into account the context of countries, sectors and companies, thus, focus on improving adaptive capacity from a systems perspective.

Background: Sepsis continues to be a major cause of death, disability, and health-care expenditure worldwide. Despite evidence suggesting that host genetics can influence sepsis outcomes, no specific loci have yet been convincingly replicated. The aim of this study was to identify genetic variants that influence sepsis survival. Methods: We did a genome-wide association study in three independent cohorts of white adult patients admitted to intensive care units with sepsis, severe sepsis, or septic shock (as defined by the International Consensus Criteria) due to pneumonia or intra-abdominal infection (cohorts 1-3, n=2534 patients). The primary outcome was 28 day survival. Results for the cohort of patients with sepsis due to pneumonia were combined in a meta-analysis of 1553 patients from all three cohorts, of whom 359 died within 28 days of admission to the intensive-care unit. The most significantly associated single nucleotide polymorphisms (SNPs) were genotyped in a further 538 white patients with sepsis due to pneumonia (cohort 4), of whom 106 died. Findings: In the genome-wide meta-analysis of three independent pneumonia cohorts (cohorts 1-3), common variants in the FER gene were strongly associated with survival (p=9·7 × 10-8). Further genotyping of the top associated SNP (rs4957796) in the additional cohort (cohort 4) resulted in a combined p value of 5·6 × 10-8 (odds ratio 0·56, 95% CI 0·45-0·69). In a time-to-event analysis, each allele reduced the mortality over 28 days by 44% (hazard ratio for death 0·56, 95% CI 0·45-0·69; likelihood ratio test p=3·4 × 10-9, after adjustment for age and stratification by cohort). Mortality was 9·5% in patients carrying the CC genotype, 15·2% in those carrying the TC genotype, and 25·3% in those carrying the TT genotype. No significant genetic associations were identified when patients with sepsis due to pneumonia and intra-abdominal infection were combined. Interpretation: We have identified common variants in the FER gene that associate with a reduced risk of death from sepsis due to pneumonia. The FER gene and associated molecular pathways are potential novel targets for therapy or prevention and candidates for the development of biomarkers for risk stratification. Funding: European Commission and the Wellcome Trust.

Nitrous oxide (N2O) is an important contributor to climate change. Human waste is an important source of N2O emissions in several world regions, and its share in global emissions may increase in the future. In this paper we, therefore, address N2O emission from human waste: collected (from treatment and from sewage discharges) and uncollected waste. We review existing literature on emissions and emission factors, and present region-specific estimates of N2O emissions and their past and future trends. We show that human waste may became an important source of N2O emissions in the coming years as a result of increasing urbanization. About two-thirds of the global emissions are from uncollected waste, and about half from South Asia. We argue that more research is needed to improve emission factors.

Background The use of minimally invasive surgery (MIS) techniques for pancreatic and liver operations remains ill defined. We sought to compare inpatient outcomes among patients undergoing open versus MIS pancreas and liver operations using a nationally representative cohort. Methods We queried the Nationwide Inpatient Sample database for all major pancreatic and hepatic resections performed between 2000 and 2011. Appropriate International Classification of Diseases, 9th Revision (ICD-9) coding modifiers for laparoscopy and robotic assist were used to categorize procedures as MIS. Demographics, comorbidities, and inpatient outcomes were compared between the open and MIS groups. Results A total of 65,033 resections were identified (pancreas, n = 36,195 [55.7%]; liver, n = 28,035 [43.1%]; combined pancreas and liver, n = 803 [1.2%]). The overwhelming majority of operations were performed open ( n = 62,192, 95.6%), whereas 4.4% ( n = 2,841) were MIS. The overall use of MIS increased from 2.3% in 2000 to 7.5% in 2011. Compared with patients undergoing an open operation, MIS patients were older and had a greater incidence of multiple comorbid conditions. After operation, the incidence of complications for MIS (pancreas, 35.4%; liver, 29.5%) was lower than for open (pancreas, 41.6%; liver, 33%) procedures (all P P = .001) as well as a lower in-hospital mortality (5.1% vs 2.8%; P = .001). Conclusion During the last decade, the number of MIS pancreatic and hepatic operations has increased, with nearly 1 in 13 HPB cases now being performed via an MIS approach. Despite MIS patients tending to have more preoperative medical comorbidities, postoperative morbidity, mortality, and duration of stay compared favorably with open surgery.

Life expectancy and longevity are influenced by air pollutants and socioeconomic status, but the extend and significance are still unclear. Better understanding how the spatial differences of life expectancy and longevity are affected by air pollutants is needed for generating public health and environmental strategies since the whole of China is now threatened by deteriorated air quality. 85 major city regions were chosen as research areas. Geographically Weighted Regression (GWR) and Stepwise Regression (SR) were used to find the spatial correlations between health indicators and air pollutants, adjusted by per capita GDP(1). The results were, regions with higher life expectancy were mainly located in the east area and areas with good air quality, a regional difference of 10 mu g/m(3) in ambient air SO22 could cause adjusted 0.28 year's difference in life expectancy, a regional difference of 10 mu g/m(3) in ambient air PM103 could lead to a longevity ratio difference of 2.23, and per capita GDP was positively associating with life expectancy but not longevity ratio, with a regional difference of 10,000 RMB4 associating with adjusted 0.49 year's difference in life expectancy. This research also showed the evidences that there exist spatially differences for ambient air PM10 and SO2 influencing life expectancy and longevity in China, and this influences were clearer in south China. (C) 2014 Elsevier B.V. All rights reserved.

a b s t r a c t Background: Gastrointestinal bleeding is the most frequent emergency for gastroenterologists. Despite advances in management, an improvement in mortality is still not evident. Aim: Determining time trends of gastrointestinal bleeding hospitalization and outcomes from 2001 to 2010 in the Veneto Region (Italy). Patients and methods: Data of patients admitted with gastrointestinal bleeding from Veneto regional discharge records were retrospectively evaluated. Chi-squared and multivariate logistic regression model were used. Results: Overall, 44,343 patients (mean age 64.2 ± 8.6 years) with gastrointestinal bleeding were analysed: 23,450 (52.9%) had upper, 13,800 (31.1%) lower, and 7093 (16%) undefined gastrointestinal bleeding. Admission rate decreased from 108.0 per 100,000 in 2001 to 80.7 in 2010, mainly owing to a decrease in upper gastrointestinal bleeding (64.4 to 35.9 per 100,000, p < 0.05). Reductions in hospital fatality rate (from 5.3% to 3%, p < 0.05), length of hospital stay (from 9.3 to 8.7 days, p < 0.05), and need for surgery (from 5.6% to 5%, p < 0.05) were observed. Surgery (OR: 2.97, 95% CI: 2.59-3.41) and undefined gastrointestinal bleeding (OR: 2.89, 95% CI: 2.62-3.19) were found to be risk factors for mortality. Conclusions: Patient admissions for gastrointestinal bleeding decreased significantly over the years, owing to a decrease in upper gastrointestinal bleeding. Improved outcomes could be related to regional dedi- cated clinical gastroenterological management.

A long stream of academic literature has established that public funding towards research and development matters for economic growth because it relates to increases in innovation, productivity and the like. The impact of public funding on the creation of new firms has received less attention in this literature despite theoretical constructs that support such association. In the present paper we study whether indeed there is a relationship between public research funds and local firm births in the context of the U.S. biotechnology industry. In doing so, we introduce a number of changes that strengthen the robustness of our findings when compared with existing literature. These changes include a direct measure of research expenditures and a considerably lengthier longitudinal dataset which allows us to capture a structural relationship and not a chance event. We empirically demonstrate that increases in the level of research funding from the National Institutes of Health towards biotechnology associate with increases in the number of biotechnology firm births at the Metropolitan Statistical Area level. Further, we reveal that public funds towards established firms associate with local firm births considerably more strongly when compared with funds towards universities and research institutes/hospitals. We conclude the paper with academic and policy implications of the present work that highlight the complexity of factors that underlie the creation of local firms in high technology industries.\ud \ud

Fatty acids (FA), phytosterols, tocopherols, phenolic compounds, total carotenoids and hydrophilic and lipophilic ORAC antioxidant capacities were evaluated in 16 cultivars of Sacha inchi (SI) seeds with the aim to valorise them and offer more information on the functional properties of SI seeds. A high a linolenic (a-Ln) fatty acid content was found in all cultivars (x3, 12.8–16.0 g/100 g seed), followed by linoleic (L) fatty acid (x6, 12.4–14.1 g/100 g seed). The ratio x6/x3 was within the 0.83–1.09 range. c- and d-tocopherols were the most important tocopherols, whereas the most representative phytosterols were bsitosterol and stigmasterol. Contents of total phenolics, total carotenoids and hydrophilic and lipophilic antioxidant capacities ranged from 64.6 to 80 mg of gallic acid equivalent/100 g seed; from 0.07 to 0.09 mg of b-carotene equivalent/100 g of seed; from 4.3 to 7.3 and, from 1.0 to 2.8 lmol of Trolox equivalent/ g of seed, respectively, among the evaluated SI cultivars. Results showed significant differences (p < 0.05) among the evaluated SI cultivars in the contents of x3, x6, antioxidant capacities and other evaluated phytochemicals. SI seeds should be considered as an important dietary source of health promoting phytochemicals. 2013 Elsevier Ltd. All rights reserved. 1. Introduction The Amazonian region is the most important area in terms of biodiversity. It hosts many important crops for the world’s agriculture (e.g., cassava, pineapple, cocoa, rubber among others). Still, numerous under exploited Amazonian plant species, with promising economic value, remain little-known and neglected by science (Krivankova et al., 2007). Sacha inchi (Plukenetia volubilis Linneo), also known as Inca peanut, wild peanut, sacha peanut or mountain peanut, is an oleaginous plant that belongs to the Euphorbiaceae family. It grows in the lowlands of the Peruvian Amazon, having been cultivated for centuries by the indigenous population (Guillén, Ruiz, Cabo, Chirinos, & Pascual, 2003; Gutiérrez, Rosada, & Jiménez, 2011; Hamaker et al., 1992; Krivankova et al., 2007). The Sacha inchi (SI) plant grows in warm climates, at altitudes of up to 1500 m above sea level. SI seeds are a good source of oil (35–60%) and protein (27%) and contain heat-labile substances with a bitter taste. SI oil is characterised predominantly by high levels of essential fatty acids, namely, C18:3 x3 (a-Ln, cis,cis,cis- 9,12,15-octadecatrienoic acid; a-linolenic) and C18:2 x6 (L, cis,- cis-9,12-octadecadienoic acid; a-linoleic) fatty acids, representing about 82% of the total oil content. The ratio of x6/x3 has been reported to be approximately 0.81 by Hamaker et al. (1992). The presence of other bioactive compounds, such as tocopherols (Follegatti- Romero, Piantino, Grimaldi, & Cabral, 2009), carotenes (Hamaker et al., 1992), polyphenolic compounds (Fanali et al., 2011) and phytosterols, have been previously reported in SI oil (Bondioli, Della Bella, & Rettke, 2006). In addition, the amino-acid profile of the SI protein fraction showed a relatively high level of cysteine, tyrosine, threonine and tryptophan, compared to other oilseed sources (Hamaker et al., 1992). SI seeds are used in different forms by the Amazonian population. The oil is used in the preparation of various meals, the seeds are consumed roasted and the leaves are cooked and consumed (Fanali et al., 2011). SI seeds are also used as a traditional remedy in the Amazon region to treat rheumatic problems and aching muscles. A wide range consumption of bioactive is important in our diet in terms of health. Thus, a-Ln and L FA are very important for the prevention of coronary heart disease and hypertension, showing a hypocholesterolemic effect (Simopoulos, 2011). In addition, numerous health benefits have been attributed to phytosterols, 0308-8146/$

Objectives The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR). Background Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR. Methods A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America. Results Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America. Conclusions With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.

Despite an effective screening programme, 600-700 women are still diagnosed with cervical cancer in the Netherlands each year. In 2009 a prophylactic vaccine against HPV-type 16 and 18 was implemented in the national immunisation programme to decrease the incidence of cervical cancer. There is evidence that infections with several oncogenic HPV types other than the vaccine types 16 and 18 are also prevented by vaccination, also known as cross-protection. Besides cervical cancer, HPV can also cause cancers at other sites such as the oropharynx, vulva, vagina and the anus/anal area. In this study we estimated the maximum health and economic benefits of vaccinating 12-year old girls against infection with HPV, taking cross-protection and non-cervical cancers into account. In the base-case, we found an incremental cost ratio (ICER) of (sic)5815 per quality adjusted life year (QALY). Robustness of this result was examined in sensitivity analysis. The ICER proved to be most sensitive to vaccine price, discounting rates, costs of cervical cancer and to variation in the disutility of cervical cancer. (C) 2013 Elsevier Ltd. All rights reserved.